NPIMap

Organization Active NPI

Pecan Valley MHMR Region

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Burleson, TX
National Provider Identifier
1942428065
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
1014217 Issued in TX
Legal business name
PECAN VALLEY MHMR REGION
Practice address
908 Brown Crest Rd
Burleson, TX 76028-5136
Phone
(817) 447-8816
NPI assigned
Apr 23, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ralph Whaite
Title
Mis Director
Phone
(940) 397-3147

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 1014217 TX Primary

Addresses

Primary practice location

908 Brown Crest Rd
Burleson, TX 76028-5136

Mailing address

650 W Green St
Stephenville, TX 76401-3311

Other identifiers 1

IdentifierTypeStateIssuer
1014217OtherDADS CONTRACT

Other names 1

  • Turkey Peak Other name

National Provider Directory

National Provider Directory
Tax ID family
Pecan Valley MHMR Region23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942428065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 W GREEN ST",
            "city": "STEPHENVILLE",
            "state": "TX",
            "postal_code": "764013311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "908 BROWN CREST RD",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760285136",
            "telephone_number": "817-447-8816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECAN VALLEY MHMR REGION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WHAITE",
        "authorized_official_first_name": "RALPH",
        "authorized_official_title_or_position": "MIS DIRECTOR",
        "authorized_official_telephone_number": "940-397-3147"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "TX",
            "license": "1014217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DADS CONTRACT",
            "identifier": "1014217",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Turkey Peak",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Burleson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.